腹腔镜前入路二级脾蒂离断术在门脉高压患者巨脾切除术中的应用  

The application of secondary splenic pedicle amputation by anterior approach in laparoscopic megalosplenia resection for portal hypertension

作　　者：王玲[1] 李亚晓[2] 邵倩倩[3] WANG Ling;LI Ya-xiao;SHAO Qian-qian(Department of Radiology,Qilu Hospital of Shandong University,Jinan 250012,China;Department of General Surgery,Qilu Hospital of Shandong University;Laboratory of Basic Medical Sciences,Qilu Hospital of Shandong University)

机构地区：[1]山东大学齐鲁医院放射科,山东济南250012 [2]山东大学齐鲁医院普通外科 [3]山东大学齐鲁医院基础医学研究中心

出　　处：《腹腔镜外科杂志》2022年第8期595-597,共3页Journal of Laparoscopic Surgery

摘　　要：目的:探讨为乙肝肝硬化合并门脉高压症患者行腹腔镜前入路二级脾蒂离断巨脾切除术的可行性及安全性。方法:2016年7月至2021年12月为20例患者采用腹腔镜前入路二级脾蒂离断术行巨脾切除术,患者均为乙肝肝硬化门脉高压症,脾脏达到巨脾标准,回顾分析手术成功率、术中出血量、胰尾损伤与胰瘘发生率、引流管拔除时间、住院时间等。结果:患者30~75岁,平均(52.40±10.72)岁,男5例,女15例。20例患者均采用腹腔镜前入路二级脾蒂离断术切除脾脏,出血量20~400 mL,平均(129.38±84.81)mL,术中、术后均未输血;手术时间115~240 min,平均(173.93±36.75)min。术后引流管拔除时间3~12 d,平均(7.10±2.32)d。均未出现胰尾损伤及胰瘘;术后出现发热3例,体温最高达39℃,经影像学检查考虑为脾静脉及结扎后食管胃底迂曲静脉内血栓导致的脾热,经积极对症治疗后体温恢复正常。术后住院5~14 d,平均(8.75±2.47)d。结论:乙肝肝硬化合并门脉高压症采用腹腔镜前入路二级脾蒂离断术行巨脾切除可取得良好效果,成功率高,并可有效避免术中大出血、胰尾损伤及术后胰瘘等并发症的发生。Objective:To investigate the feasibility and safety of laparoscopic secondary splenic pedicle disconnection via a nterior approach for giant splenectomy in hepatitis B cirrhosis patients with portal hypertension.Methods:From Jul.2016 to Dec.2021,20 patients underwent laparoscopic secondary splenic pedicle dissection via anterior approach for giant splenectomy.All patients were diagnosed with hepatitis B cirrhosis and portal hypertension,and spleen in these patients reached the standard of megalosplenia.The data including patients'characteristics,success rate of surgery,intraoperative blood loss,incidence of pancreatic tail injury and p ancreatic fistula,drainage tube removal time and hospital stay were retrospectively analyzed.Results:The 20 patients included 5 males and 15 females,ages ranged from 30 to 75 years with the average of(52.40±10.72)years.The spleen was removed by laparoscopic secondary splenic pedicle dissection via anterior approach.No hemorrhage occurred in all patients,and the blood loss ranged from 20 to 400 mL with the average of(129.38±84.81)mL.None of the patients were given blood transfusion during or after the operation.The operation time ranged from 115 to 240 min,with an average of(173.93±36.75)min.The success rate of the operation was 100%.The drainage tube removal time ranged from 3 to 12 d,with an average of(7.10±2.32)d.There were no pancreatic tail injury or pancreatic fistula.Fever occurred in 3 cases after the operation,and the highest body temperature was 39℃.After imaging examination,the fever was considered to be splenic heat caused by thrombus in splenic vein and tortuous vein of the esophagus and gastric fundus after l igation,and the body temperature returned to normal after symptomatic treatment.The postoperative hospital stay ranged from 5 to 14 d,the mean was(8.75±2.47)d.Conclusions:In patients with hepatitis B cirrhosis and portal hypertension,the laparoscopic secondary splenic pedicle dissection via anterior approach for giant splenectomy can achieve good clinical o

关 键 词：高血压 门静脉 巨脾 脾切除术 腹腔镜检查 二级脾蒂 

分 类 号：R657.6[医药卫生—外科学]